Home quarantine during COVID-19 blunted childhood trauma-related psychiatric symptoms in Chinese college students.

Background: Childhood trauma confers risks to mental health. However, little is known about whether home quarantine (HQ) during the coronavirus disease 2019 (COVID-19) pandemic exaggerated or mitigated the effect of childhood trauma on mental health. Objective: To examine the modulating effects of prior childhood traumas on the longitudinal changes of psychiatric symptoms in college students before and after HQ during the pandemic. Methods: This was a two-wave longitudinal study on the mental health of 2,887 college students before and after HQ during the COVID-19 pandemic. The relationships between the changes in the Patient Health Questionnaire-9 (PHQ-9), Symptom Checklist-90 (SCL-90), 16-item Prodromal Questionnaire (PQ-16), Childhood Trauma Questionnaire (CTQ), and Social Support Rating Scale (SSRS) scores were analyzed. Results: The students with childhood trauma showed a significantly greater decrement in psychiatric symptoms after HQ (F = 17.21, 14.11, 18.87, and 17.42 for PHQ-9, PQ-16 objective and distress, and SCL-90, respectively). The correlation coefficients between the CTQ and these symptoms scales were significant at baseline (r = 0.42, 0.34, 0.37, and 0.39), and decreased after HQ (r = 0.17, 0.20, 0.18, and 0.19). The decrement of depressive, psychotic, and overall symptoms was positively correlated with the scores of the CTQ (r = 0.08-0.27) but negatively correlated with SSRS (r = -0.08--0.14). Multilinear regression analysis confirmed the results of the CTQ and SSRS regarding the modulation of the dynamic changes in psychiatric symptoms. A constructed structural equation model indicated that the total effects of childhood trauma on decreased psychiatric symptoms were partly mediated by lower baseline social support. Conclusion: Home quarantine during the COVID-19 pandemic could blunt the adverse effects of childhood trauma on mental health, especially for prodromal psychotic symptoms in college students. Changes in relative deprivation and social support may be mediating factors.

Resilience in alcohol use disorder: associations with negative and positive emotionality, quality of life, and disorder severity

In previous work looking at individuals exposed to childhood trauma, we have found that decreased neuroticism, impulsivity, and trait anxiety, and increased conscientiousness are associated with a decreased risk of alcohol use disorder (AUD), suggesting these characteristics contribute to a relative resilience to alcohol misuse. In the current study we confirm and expand on these findings using the Connor-Davidson Resilience Scale (CD-RISC), which assesses resilience based on individual characteristics and coping mechanisms as well as social relationships. We analyzed CD-RISC data from two NIAAA protocols: 1) the Natural History Protocol (NHP) (n = 245;156 with AUD, 89 without AUD);2) the COVID-19 Pandemic Impact on Alcohol Protocol (C19PIA) (n = 280;77 with AUD, 203 without AUD). Participants ranged from non-drinking healthy volunteers to heavy drinkers. In addition to the CD-RISC, assessments included the Structured Clinical Interview for DSM-5 disorders, and questionnaires related to problematic alcohol use, positive and negative affect, personality, perceived stress, and quality of life (i.e., physical health, psychological health, social relationships, and environment). Data analysis was conducted using general linear models, and analyses were run separately for the two independent samples due to differences in data collection methodology. For the C19PIA protocol sample, analyses were conducted on measures collected both pre-pandemic and during the pandemic. In both the NHP and C19PIA samples, CD-RISC score was negatively associated with neuroticism, negative affect, and perceived stress, and positively associated with extraversion, conscientiousness, positive affect, and all four quality of life measures. In the C19PIA sample, these results were consistent for analyses of both pre-pandemic and pandemic-associated measures. CD-RISC score was lower in individuals with AUD compared to those without AUD. In the NHP sample, which was enriched for individuals with AUD, greater resilience was associated with decreased AUD severity, and decreased anxiety and depression symptoms, among those diagnosed with AUD. A similar association between resilience and decreased AUD severity was observed in the C19PIA sample before the pandemic. Resilience was also associated with a reduction in impaired control over drinking in the C19PIA sample, both before and during the pandemic. The current findings highlight resilience as a key construct associated with multiple factors at the individual, social, and environmental levels. Of note, the same resilience-associated factors were observed both before and during the COVID 19 pandemic, with the latter representing a major stressor for many individuals. The finding that greater resilience is associated with decreased disorder severity and reduced depression and anxiety symptoms among those with AUD highlights the potential of resilience-oriented approaches to treatment. These approaches, often promoted for trauma-exposed individuals, could also prove beneficial for alcohol use disorder.Copyright © 2023

Cognitive, Motor, & Negative Valence Systems in Neurologic Pasc: A Preliminary Study

Background: Nervous system post-acute sequelae of COVID-19 (NS-PASC) include cognitive and mental health symptoms. To further define these, we applied a Research Domain Criteria (RDoC) approach to examine motor, positive valence (PV) and negative valence (NV) systems, and social processing data in The COVID Mind Study of NS-PASC. Method(s): NS-PASC participants (>3 months after COVID-19) referred from a NeuroCOVID Clinic and non-COVID controls from New Haven, CT and Baltimore, MD completed an RDoC test battery for cognition (language, declarative and working memory, cognitive control, perception), motor, PV, NV, and social processes. To date, 3T MRI with diffusion tensor imaging was performed in 11 NS-PASC to assess white matter integrity (global white matter fractional anisotropy [FA]) as a contributor to alterations identified on the RDoC tests. Analysis of Covariance examined group differences after adjusting for sex, race, ethnicity, age, and years of education. Result(s): 25 NS-PASC participants (age 43.4+/-11.3 yrs, 76% female, 402 days after COVID-19 symptom onset) and 29 controls (age 46.2.6+/-13.1 yrs, 66% female) completed the battery. Controls were more racially diverse and less educated than NS-PASC (43% vs. 12% Black, p=0.005;14.5 vs. 16.1 yrs of education, p< 0.05). Means and statistics for RDoC between NS-PASC and controls are shown in Table. NS-PASC performed worse in language, verbal working and declarative memory, and perception and reported greater cognitive control difficulties (e.g., behavioral inhibition, set shifting) without issues on performance-based metrics (Stroop, Trail Making Test-Part B), and had slower motor function. NS-PASC reported more NV issues including greater symptoms of depression, rumination in response to depressive mood, apathy, childhood trauma, anxiety, and perceived stress. There were no differences in PV and social processing. In a subset of NS-PASC participants who underwent MRI, there was a dynamic range of FA values with a mean of 0.509 (IQR 0.481 - 0.536). Conclusion(s): Our findings extend previous PASC studies characterizing cognitive and mental health alterations, indicating that additional RDoC assessments warrant focus, including alterations in motor and the negative valence system. In future analyses, we will examine white matter integrity as a pathophysiologic contributor to these RDoC systems.

A Traumatic Pandemic: High Acuity Pediatric Trauma in the Covid-19 Era

Purpose of study COVID-19 has shifted the utilization of health care resources. Gaps remain in our understanding on how COVID-19 affects trends in pediatric trauma, the leading cause of mortality and morbidity during childhood and adolescence. We identified trends in the numbers and types of traumas presenting to a Level 1 Pediatric Trauma Center during the COVID-19 pandemic compared to prior years. Methods used We compared high acuity trauma visits (defined as traumas requiring admission, emergent surgical intervention or resulting in a fatality) presenting between January 1st and August 31st, 2020 to corresponding months in 2017-2019. We also evaluated the changes in mechanisms of injury during this time period. Data were analyzed using longitudinal time series analyses and t-tests. Summary of results Of 480 traumas presenting from January to August 2020, 227 (47.3%, 95%CI 42.7%-51.9%) were high acuity traumas. High acuity traumas declined significantly, as a state of emergency was declared, to a nadir of 16 in April 2020 (compared to the 2017-2019 mean of 38.3, p<0.001). As restrictions were lifted, high acuity traumas increased and surpassed previous years to a peak of 40 visits in August 2020 (2017-2019 mean 35.7, p<0.001). High acuity traumas as a proportion of total Emergency Department visits were higher from March to August 2020 compared to prior years (figure 1). There were more visits for high acuity assaults and child abuse but fewer for falls, drownings, and motor vehicle accidents from March to August 2020 compared to prior years, while visits for animal attacks remained stable Conclusions This analysis provides insight into how the COVID-19 pandemic has affected high acuity trauma in an inner-city pediatric population. Findings may be used to guide public health measures on safety and injury prevention as the pandemic continues and further restrictions are debated. (Figure Presented).

Mental health providers' perspectives: The link between childhood trauma, juvenile delinquency and long-term effects

Juvenile delinquency is an ongoing problem in society and is detrimental as many delinquents have mental and behavioral health issues. Delinquency is costly to society, and it was found that many delinquents have a traumatic past or adverse childhood experiences. They include child abuse and neglect, loss, separation/divorce of parents, witnessing domestic violence, parents who struggle with mental health and/or drug and substance abuse, parents who have their own trauma, death of a loved one, natural disaster, or other tragedies that are linked to an increase in the likelihood of juvenile delinquency. In this study, the relationship between juvenile delinquency and trauma by the lived experiences of professionals who have worked with delinquents and at-risk youth was examined. The biopsychosocial model provided a theoretical framework for the study. Data were collected by interviewing 20 mental health professionals. The data were analyzed to determine common themes and patterns about professionals who work with at-risk youth. The 6 themes found during analysis were professionals' caseloads consisted of clients who have lived through trauma, vicarious trauma was common, professionals must adapt to the barriers that stem from working with the population, they faced many barriers working with at-risk youth, they wanted to be effective for their clients, they were interested in trainings to increase their effectiveness with clients, they found it was necessary for caregivers to be involved in treatment, and COVID-19 has impacted traumatized youth. This study can contribute to positive social change as professionals may be able to identify ways to intervene with at-risk youth to encourage normal social functioning. (PsycInfo Database Record (c) 2022 APA, all rights reserved)

Low Treatment Fidelity as an Indication to Switch Interventions: Pivoting From Child-Parent Psychotherapy to Parent-Child Interaction Therapy for Early Childhood Trauma

Young children who experience trauma and adverse experiences are at an increased risk of developing an insecure attachment style as well as negative physical and mental health problems. These can include internalizing and externalizing behavioral problems, developmental delay, emotional dysregulation, and aggression. Several evidence-based interventions exist to treat young children with symptoms related to trauma, each with different foundational theories. This article presents the case of a 4-year-old boy with posttraumatic stress disorder who was in the middle of a legal fight between caregivers and transitioning between caregivers' homes. Initially, therapy began with Child-Parent Psychotherapy to address caregivers' first concerns. Later, the therapeutical approach was switched to Parent-Child Interaction Therapy due to difficulty with treatment fidelity related to caregivers' symptoms and conflict. This case demonstrates great improvement in treatment fidelity and subsequently problem behaviors after switching to an intervention that allowed to address behavior management shortcomings in a family with ongoing conflict.Copyright © The Author(s) 2022.

Childhood Trauma and Suicide.

Background: Suicide is a leading cause of death worldwide, and childhood trauma has been found to be an important risk factor. However, the mechanisms linking trauma to suicide risk remain unclear. Aims: The current registered report sought to (1) investigate whether childhood trauma and its subtypes were related to suicide risk in adulthood and (2) explore the potential mechanisms associating childhood trauma with suicide and well-being, especially executive functioning, impulsivity, and stress. Method: A cross-sectional survey of 457 individuals who reported experiencing suicide ideation in the past 12 months. Results: Childhood trauma and its subtypes were associated with an increased risk of reporting recent suicide thoughts, COVID-19-related suicide attempts, and recent suicide attempts. There were also significant indirect effects of childhood trauma on recent suicide ideation and well-being through executive functioning and impulsivity. Conclusion: These findings show that childhood trauma is associated with suicide risk in adulthood and suggest that poorer executive functioning and higher levels of impulsivity contribute to this increased risk. These results have implications for the development of future interventions to reduce suicide vulnerability.

Psychosocial factors associated with the risk of developing psychosis in a Mexican general population sample.

Epidemiological evidence has linked an array of sociodemographic and psychosocial factors with an increased risk of developing psychosis. However, research in samples from low- and middle-income countries is still scarce. This study used a Mexican sample to explore (i) sociodemographic and psychosocial differences between individuals with and without a positive screen for Clinical High-Risk for psychosis (CHR), and (ii) sociodemographic and psychosocial factors associated with screening positive for CHR. The sample consisted of 822 individuals from the general population who completed an online survey. Of the participants, 17.3% (n = 142) met the CHR screening criteria. Comparisons between those who screened positive (CHR-positive group) and those who did not (Non-CHR group) showed that participants in the CHR-positive group were younger, had a lower educational level, and reported more mental health problems than the Non-CHR group. Furthermore, relative to the Non-CHR group, the CHR-positive group had a greater prevalence of medium/high risk associated with cannabis use, a higher prevalence of adverse experiences (bullying, intimate partner violence, and experiencing a violent or unexpected death of a relative or friend), as well as higher levels of childhood maltreatment, poorer family functioning, and more distress associated with the COVID-19 pandemic. Groups did not differ in sex, marital/relationship status, occupation, and socio-economic status. Finally, when examined in multivariate analyses, the variables associated with screening positive for CHR were: having an unhealthy family functioning (OR = 2.75, 95%CI 1.69-4.46), a higher risk associated with cannabis use (OR = 2.75, 95%CI 1.63-4.64), a lower level of education (OR = 1.55, 95%CI 1.003-2.54), having experienced a major natural disaster (OR = 1.94, 95%CI 1.18-3.16), having experienced a violent or unexpected death of a relative or friend (OR = 1.85, 95%CI 1.22-2.81), higher levels of childhood emotional abuse (OR = 1.88, 95%CI 1.09-3.25), physical neglect (OR = 1.68, 95%CI 1.08-2.61), and physical abuse (OR = 1.66, 95%CI 1.05-2.61), and higher COVID-related distress (OR = 1.10, 95%CI 1.01-1.20). An older age was a protective factor for screening positive for CHR (OR = 0.96, 95%CI 0.92-0.99). Overall, the findings highlight the importance of examining potential psychosocial contributors to psychosis vulnerability across different sociocultural contexts to delineate risk and protective processes relevant to specific populations and better target preventive intervention efforts.

Trajectory of suicidal ideation among medical students during the COVID-19 pandemic: the role of childhood trauma.

BACKGROUND: The aim of this study was to understand the longitudinal trajectory of suicidal ideation (SI) among Chinese medical students and the role of childhood trauma (CT). METHODS: Using a whole-group sampling method, we assessed SI in 2192 (male = 834, female = 1358) medical students on three occasions over a period of one year. The Suicidal Ideation Self-Assessment Scale (SISAS) and the Childhood Trauma Questionnaire-Short Form (CTQ-SF) were used to assess SI and CT. The growth mixture modeling (GMM) was used to classify the developmental trajectory of SI. RESULTS: A greater number of medical students were experiencing suicidal ideation during the COVID-19 pandemic. The trajectory of SI among medical students was divided into two groups: a low risk, slowly rising group and a high risk, continuous group. The low risk, slowly rising group had a significant time effect (B = 1.57, p < 0.001) and showed a slowly increasing trend. Emotional neglect (EN), physical neglect (PN), emotional abuse (EA) and physical abuse (PA) all had significant positive predictive effects for the high risk, continuous group (B = 0.18-0.65, P < 0.01). CONCLUSION: The trajectory of SI among medical students can be divided into a low risk, slowly rising group and a high risk, continuous group; the more EN, PN, EA and PA experienced during childhood, the more likely medical students are to develop a high risk, continuous state of SI.

Conspiracy beliefs and COVID-19 guideline adherence in adolescent psychiatric outpatients: the predictive role of adverse childhood experiences.

BACKGROUND: Conspiracy beliefs have become widespread throughout the COVID-19 pandemic. Previous studies have shown that endorsing conspiracy beliefs leads to lower protective guideline adherence (i.e., wearing face masks), posing a threat to public health measures. The current study expands this research across the lifespan, i.e., in a sample of adolescents with mental health problems. Here, we investigated the association between conspiracy beliefs and guideline adherence while also exploring the predictors of conspiracy beliefs. METHODS: N = 93 adolescent psychiatric outpatients (57% female, mean age: 15.8) were assessed using anonymous paper-pencil questionnaires. Endorsement of generic and COVID-19 conspiracy beliefs was assessed, in addition to items measuring adherence to protective guidelines and mental health (stress, depressive symptoms, emotional/behavioral problems, and adverse childhood experiences). Multiple regressions and supervised machine learning (conditional random forests) were used for analyses. RESULTS: Fourteen percent of our sample fully endorsed at least one COVID-19 conspiracy theory, while protective guidelines adherence was relatively high (M = 4.92, on a scale from 1 to 7). The endorsement of COVID-19 conspiracy beliefs-but not of generic conspiracy beliefs-was associated with lower guideline adherence (ß = - 0.32, 95% CI - 0.53 to - 0.11, p < .001). Conditional random forests suggested that adverse childhood experiences and peer and conduct problems were relevant predictors of both conspiracy belief categories. CONCLUSION: While a significant proportion of our sample of adolescents in psychiatric treatment endorsed conspiracy beliefs, the majority did not. Furthermore, and to some degree, contrary to public perception, we found that adolescents show relatively good adherence to public health measures-even while experiencing a high degree of mental distress. The predictive value of adverse childhood experiences and peer/conduct problems for conspiracy beliefs might be explained by compensatory mechanisms to ensure the safety, structure, and inclusion that conspiracies provide.

Harnessing Community Resources to Enhance Student Learning and Development

One of the most important ways in which school social workers can support students, families, and staff is by acquiring, developing, and distributing community resources. This chapter will discuss identifying needs, assembling resources, empowering students and families to access resources, and building staff and program capacity to meet community needs. Discussion will focus on needs assessments during the overlapping pandemics of COVID-19 and racial inequities. Strategies for conducting needs assessments, mapping assets, and investigating potential community partners are offered. Finally, the chapter covers the importance of collecting and reporting data to evaluate the success of the programs that the school social worker develops. © Oxford University Press 2022. All rights reserved.

A Biopsychosocial Formulation of Psychosis after Kidney Transplantation: When Cultural Identity and Biology Collide

Background: When working with colleagues of predominantly biological perspectives, it is an important role of the consultation psychiatrist to recognize psychosocial factors that may be impacting a patient's pathology. This case exemplifies the importance of such education between psychiatric and transplant providers. Case: This is a 38-year-old divorced Russian man, with history of cannabis use and childhood trauma;and history of ESRD secondary to IgA nephropathy s/p DDKT on tacrolimus/mycophenolate/prednisone. Eighteen months after transplantation, in the setting of daily cannabis use, he developed psychosis with persecutory delusions, referential experiences, and experiences of thought alienation. The content of his delusions was tied closely to his experience of emigration from Russia, having spent his childhood in Volgograd/Stalingrad after the dissolution of the USSR. He was found to have a tacrolimus level of 20, above goal-range of 8-10. He was medically hospitalized and followed by psychiatry. The medical, transplant, and psychiatry teams collaborated to downtitrate his tacrolimus and initiate treatment with antipsychotic medication. His psychosis initially improved but recurred six months after discharge. At that time, there were several changes to his presentation of diagnostically significance. His tacrolimus level was found to be within goal. He had also recently recovered from COVID-19, self-discontinued olanzapine, and ceased cannabis use. The patient's new persecutory delusions developed concurrently with the conflict between Russia and Ukraine, raising suspicion that activation of trauma was playing a larger role. Discussion(s): Biologically, the effect of cannabis on immunosuppression through CYP3A4 inhibition is relevant, as is the independent relationship between cannabis, tacrolimus and psychosis1,2 At the time of writing, any effect of the change to belatacept is yet unknown. Psychologically, trauma history likely contributed to suspiciousness toward others and persecutory delusions. There is also evidence to suggest a relationship between trauma, cannabis and psychosis.3 Culturally, his sensation of being targeted was likely related to his Russian identity, immigrant status, and the current international conflict. Conclusion/Implications: This case demonstrates multiple contributing factors to psychosis in a patient post-transplant, which include psychological, trauma-related, and cultural factors in addition to those explained by pathophysiology of transplant, substance use, and immunosuppression. Transplant psychiatry has an essential role in educating our colleagues and patients about the multitude of contributors to psychiatric health post-transplant. References: 1. Nogueira JM, Freire MJ, Nova VV, Jesus G. When Paranoia Comes with the Treatment: Psychosis Associated with Tacrolimus Use. Case Rep Nephrol Dial. 2021;11(2):241-246. 2. Sikavi D, McMahon J, Fromson JA. Catatonia Due to Tacrolimus Toxicity 16 Years After Renal Transplantation: Case Report and Literature Review. J Psychiatr Pract. 2019;25(6):481-484. 3. Tomas-Roig J, Piscitelli F, Gil V, et al. Effects of repeated long-term psychosocial stress and acute cannabinoid exposure on mouse corticostriatal circuitries: Implications for neuropsychiatric disorders. CNS Neurosci Ther. 2018;24(6):528-538. Copyright © 2022

Review of a regional paediatric trauma service

Introduction/Aims: Sheffield Children's NHS Foundation Trust (SCH) is a paediatric major trauma centre, covered by a regional on-call oral and maxillofacial surgery (OMFS) team. Referrals are taken from across South Yorkshire and North Derbyshire. We carried out a retrospective review of all emergency referrals to OMFS to establish indications for referral and review management. Material(s) and Method(s): We reviewed all on-call data from October 2018 - July 2020 to evaluate date assessed, referral source, diagnosis, admission, surgical intervention, follow up and demographic data. This was then compiled in a dataset and analysed. Results/Statistics: Over the period evaluated, 669 patients were referred to OMFS at SCH. Of all referrals, 68.6% were from SCH and other emergency departments accounted for 3.7%. Reasons for referral included lacerations (59.6%), dental infections (13.8%), dental trauma (13.9%) and facial fractures (3.9%). Of patients assessed, 24% required admission and at least 65.6% needed surgical intervention. 43% patients required follow-up of their injuries. Since the onset of the Covid-19 pandemic, there has been an increase in the number of phone reviews, accounting for 2.7% of follow-up appointments over the total time period. Conclusions/Clinical Relevance: The majority of referrals to paediatric OMFS are related to soft tissue trauma, and a majority require surgical intervention. A significant proportion of patients required follow up after discharge. The data gathered supports the need for OMFS access to emergency theatres and day-case facilities, in order to enable the effective running of a regional paediatric trauma service. Copyright © 2022

Mental health providers' perspectives: The link between childhood trauma, juvenile delinquency and long-term effects

Juvenile delinquency is an ongoing problem in society and is detrimental as many delinquents have mental and behavioral health issues. Delinquency is costly to society, and it was found that many delinquents have a traumatic past or adverse childhood experiences. They include child abuse and neglect, loss, separation/divorce of parents, witnessing domestic violence, parents who struggle with mental health and/or drug and substance abuse, parents who have their own trauma, death of a loved one, natural disaster, or other tragedies that are linked to an increase in the likelihood of juvenile delinquency. In this study, the relationship between juvenile delinquency and trauma by the lived experiences of professionals who have worked with delinquents and at-risk youth was examined. The biopsychosocial model provided a theoretical framework for the study. Data were collected by interviewing 20 mental health professionals. The data were analyzed to determine common themes and patterns about professionals who work with at-risk youth. The 6 themes found during analysis were professionals' caseloads consisted of clients who have lived through trauma, vicarious trauma was common, professionals must adapt to the barriers that stem from working with the population, they faced many barriers working with at-risk youth, they wanted to be effective for their clients, they were interested in trainings to increase their effectiveness with clients, they found it was necessary for caregivers to be involved in treatment, and COVID-19 has impacted traumatized youth. This study can contribute to positive social change as professionals may be able to identify ways to intervene with at-risk youth to encourage normal social functioning. (PsycInfo Database Record (c) 2022 APA, all rights reserved)

The Prevalence, Patterns and Correlates of Childhood Trauma Exposure in a Nationally Representative Sample of Young People in Northern Ireland.

Purpose: Childhood trauma (CT) exposure is common, with many young people affected by multiple co-occurring traumas. Methods: Participants were a representative sample of 11-19-year-olds (n = 1293), who participated in the largest ever representative survey of youth mental health in Northern Ireland (NI) - the NI Youth Wellbeing Prevalence Survey 2020. This study used latent class analysis (LCA) to identify typologies that were most representative of trauma experience and co-occurrence among young people living in NI. Demographic, parental and deprivation variables were then used within a multinomial logistic regression analysis to describe trauma class membership. Results: Over 35% (n = 478) of participants reported exposure to at least one CT, with over 50% (n = 259) of trauma-exposed young people reporting multiple trauma exposure. LCA results provided support for a three-class model; 'low-exposure', 'moderate-exposure: community-victimization' and 'high-exposure: sexual-trauma'. While none of the child, parental or familial covariates differentiated members of the 'moderate-exposure: community-victimization' from 'low-exposure', those in 'high-exposure: sexual-trauma' were over four and a half times more likely to belong to a family in receipt of income benefits and over ten times more likely to have experienced some form of out-of-home care. Conclusions: This study highlights the presence of three distinct trauma classes in the NI adolescent population. In particular, this study identifies a small minority of young people who have experienced multiple CT's, including sexually based traumas, with these traumas most likely to have occurred in the context of out-of-home care and familial poverty.

Older adults during the pandemic: Mental health symptoms are predicted by childhood trauma

Introduction: It has been broadly anticipated that COVID-19 pandemic-related experiences may constitute traumatic stressors in vulnerable populations, and that older adults' might be especially at risk of experiencing mental health symptoms during the pandemic. Objective(s): The present study aimed to examine older adults' psychological distress: posttraumatic stress, Covid-related fears, anxiety, and depression during the pandemic, and the relationship between present distress, defensive functioning, and childhood trauma. We also explored potential differences between youngerolder adults (between 65 and 74 years), and older-older adults (75 years and above). Method(s): Data was collected in a large-scale online survey during the early months of the pandemic, for the present study, we included participants above 65 years old (N = 1,225). Result(s): showed that age, adverse childhood experiences, and overall defensive functioning were all significantly related to posttraumatic stress, anxiety, and depression. Specifically, younger age and more reported childhood adversity were related to higher distress, whereas higher defensive functioning was related to less distress. Covid-related fears were not associated with age. Our final model showed that defensive functioning mediated the relationship between childhood trauma and distress. Conclusion(s): Our results support the relative resilience of olderolder adults compared to younger-older adults, as well as the longlasting impact of childhood adversity through defensive functioning later in life, specifically in times of heightened stress, such as the COVID-19 pandemic. Future studies are warranted to identify further factors affecting defensive functioning as adults age, as well as processes that are associated with resilience in response to stressors in older adulthood.

Associations between COVID-19 pandemic impact, dimensions of behavior and eating disorders: a longitudinal UK-based study

Introduction: There is growing concern about how people with eating disorders are impacted by the widespread societal restructuring during the COVID-19 crisis. Objective(s): We aimed to examine how factors relating to the impact of the pandemic associate with eating disorders and quantify this relationship while adjusting for concurrent and longitudinal parameters of risk. Method(s): We gathered demographic, behavioral and clinical data pre- and mid-pandemic as well as childhood trauma history from a longitudinal online survey of 489 adults (mean age 23.4 years) recruited from the Neuroscience in Psychiatry Network (NSPN). Using pre-pandemic (T1) and concurrent (T2) data we aimed to predict eating disorders at mid-pandemic (T2). We deployed hierarchical generalized logistic regression to ascertain the strength of longitudinal and concurrent associations. Result(s): Pre-pandemic eating disorder scores strongly associated with concurrent eating disorder (z=5.93). More conflict at home mid-pandemic (z=2.03), pre- (lower sensation seeking z=-2.58) and mid-pandemic (higher lack of perseverance z=2.33) impulsivity traits also associated with mid-pandemic eating disorder. Significant correlations between pandemic-related disrupted lifestyle and eating disorder psychopathology both pre- and mid-pandemic were observed. Conclusion(s): Conflict at home mid-pandemic and specific aspects of impulsiveness significantly associated with concurrent eating disorder when adjusted for pre-pandemic eating disorder symptoms, baseline demographics, behavioral traits, history of traumatic experiences and concurrent psychopathology. These results provide insight into the struggles of those suffering with eating disorders during the COVID-19 pandemic and highlight the importance of impulsiveness traits and the immediate family environment in their experience of illness during the pandemic.

Necrotizing Myopathy Following COVID-19 Vaccination: A Case Report

Case Diagnosis: Necrotizing Myopathy Following COVID-19 Vaccination: a case report Case Description or Program Description: An 86-year-old male presented with bilateral LE weakness and dark urine four days after administration of second dose of COVID-19 vaccination. He was diagnosed with UTI by his PCP. On admission to hospital, workup revealed elevated CK and elevated inflammatory markers. Serological workup was negative for autoimmune disease. Setting(s): Major academic and referral center with Level I adult trauma and Level II pediatric trauma status Assessment/Results: His initial diagnosis was attributed to inflammatory myositis versus rhabdomyolysis. He was started on intravenous steroids. A thigh biopsy demonstrated necrotizing myopathy, and etiology was attributed to COVID-19 vaccination. EMG was not warranted given established diagnosis. He was ultimately discharged to a subacute rehabilitation facility for functional improvement. Discussion (relevance): This case demonstrates a patient with a rare and unusual side effect attributed to COVID-19 vaccination. While the differential could include a statin-induced myopathy, it is unlikely given he had been on the same statin for several years. The other etiology could certainly be idiopathic, but chronological proximity to the vaccine seems too coincidental. There has been a case in the literature describing a female patient who experienced left UE progressive weakness and myalgias at the site of her second COVID-19 vaccination. MRI of the left shoulder showed diffuse edema and inflammation consistent with myositis. She did not have muscle biopsy. It has been documented that muscle is subject to modified contaminated agents through direct inoculation which can consequently trigger an immune response to the injected antigen. Conclusion(s): This is an elderly patient who developed progressive LE paraparesis after COVID-19 vaccination attributed to necrotizing myopathy based on muscle biopsy. Further studies should investigate the incidence of necrotizing myopathy from the novel mRNA COVID-19 vaccination as it may be underdiagnosed, and if there are other predisposing factors for individuals to develop such pathology.

Blended Delivery of Imagery Rescripting for Childhood PTSD: A Case Study During the COVID-19 Pandemic.

Background: Despite the growing evidence that trauma-focused treatments can be applied as first-line approaches for individuals with childhood trauma-related PTSD (Ch-PTSD), many therapists are still reluctant to provide trauma-focused treatments as a first-choice intervention for individuals with Ch-PTSD, especially by telehealth. The current manuscript will therefore give an overview of the evidence for the effectiveness of trauma-focused therapies for individuals with Ch-PTSD, the delivery of trauma-focused treatments via telehealth, and a case example on how a specific form of trauma focused therapy: Imagery Rescripting (ImRs) can be applied by telehealth. Method: This article presents a clinical illustration of a blended telehealth trajectory of imagery rescripting (ImRs) Ch-PTSD delivered during the COVID-19 pandemic. Results: The presented case shows that ImRs can be safely and effectively performed by telehealth for ch-PTSD, no stabilization phase was needed and only seven sessions were needed to drastically reduce Ch-PTSD and depressive symptoms, and to increase quality of life. Conclusion: This case report shows the effectiveness of ImRs by telehealth for Ch-PTSD, which gives hope and additional possibilities to reach out to patients with ch-PTDS. Telehealth treatment might have some of advantages for specific patients, especially, but certainly not only, during the pandemic.

Pediatric major trauma. Anaesthesia education: Airway, breathing, coffee and cases 2020-2021

Background: Trauma calls with substantial injuries are low volume;exposure per fellow is low. A pilot questionnaire demonstrated that fellows were unaware of colleagues' trauma workload. There was no standardized process for departmental case review. With COVID-19 precautions limiting face-to-face time with colleagues, we were concerned that learning may be affected. We aimed to improve education by identifying cases with high potential for shared learning or system improvement and instigating a triannual Coffee and Cases meeting. Method(s): We devised a feedback form for trainees to fill in following each trauma team activation. These data were combined with trauma registry data to provide an overall perspective on the anesthesia workload for trauma and presented via Teams to the entire department. Infographics were used to illustrate cases and highlight important learning points. These were combined with up-to-date literature regarding pediatric trauma management. Trainees were reaudited following the talk. Result(s): During the pilot questionnaire, just 14.3% of fellows agreed with the statement: I am aware of the number of trauma calls, mechanisms of trauma and injuries sustained, presenting to Sick Kids in the previous month. In total, 71.4% disagreed and 14.3% strongly disagreed. Reaudit in November 2020 following the Coffee and Cases meeting online via Teams showed 100% agreement, with 71.4% strongly agreeing. Because of clinical commitments, it is often not possible for all relevant and interested staff members to attend such meetings, so a supplementary update PDF was provided via hospital email. Issues were identified regarding communication (team briefing), billing and prompt drug availability. These issues were addressed and reaudited. Conclusion(s): The questionnaire allowed us to collect real-time feedback on our trauma service and collate learning points from cases. This was integrated with up-to-date literature. Trauma patients may present critically unwell, yet the environment may be unfamiliar to rotating staff. Education is vital. Infographics helped us to illustrate cases, highlighting important learning points. These are 30 times more likely to be read than text so can successfully improve readership and learning of information..